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Cataract surgery with the AlphaCor artificial cornea.

Hiroshi Eguchi1, Celia R Hicks, Geoffrey J Crawford

  • 1Lions Eye Institute and Centre for Ophthalmology and Visual Science, University of Western Australia, Nedlands 6009, WA, Australia.

Journal of Cataract and Refractive Surgery
|June 24, 2004
PubMed
Summary

This review examines the results of performing cataract surgery alongside the implantation of the AlphaCor artificial cornea. Researchers found that these combined procedures often lead to more complications and poorer vision compared to patients who did not require cataract surgery. The study highlights the technical challenges of operating through this specific artificial device and suggests that surgical techniques need improvement. Better imaging and anti-inflammatory treatments might help manage risks like tissue melting or glaucoma. These findings provide important insights for surgeons managing patients with complex corneal and lens issues.

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Area of Science:

  • Ophthalmology research focusing on AlphaCor artificial cornea implantation
  • Surgical outcomes analysis within clinical medicine

Background:

No prior work has fully resolved the clinical challenges associated with performing cataract extraction in eyes already fitted with synthetic corneal devices. That uncertainty drove this investigation into the outcomes of combined surgical interventions. It was already known that traditional lens removal techniques face significant hurdles when the ocular surface is replaced by artificial materials. Prior research has shown that maintaining clear visualization during such procedures remains a persistent obstacle for clinicians. This gap motivated a comprehensive review of multicenter trial data to assess patient safety and visual performance. The literature lacks consensus on whether concurrent lens removal compromises the stability of the synthetic implant. Previous studies often focused on the primary device implantation rather than the secondary management of lens opacities. This analysis addresses the specific risks encountered when these two complex ophthalmic procedures intersect in a clinical setting.

Purpose Of The Study:

Keywords:
ophthalmic surgerycorneal implantvisual acuitypostoperative complications

Frequently Asked Questions

The researchers propose that the combined procedure leads to an increased incidence of complications like tissue melt and glaucoma. Furthermore, patients undergoing these surgeries experienced worse mean best corrected visual acuity compared to those who received the artificial cornea without needing lens removal.

The authors identify the AlphaCor device, manufactured by Argus Biomedical Pty Ltd., as the specific synthetic implant used in this multicenter clinical trial. This artificial cornea replaces the natural tissue, creating a restricted view that complicates subsequent surgical maneuvers.

The researchers note that the restricted view through the artificial device makes the procedure difficult. This limitation often results in the retention of residual soft lens matter, which necessitates improved imaging techniques to ensure complete removal during the operation.

Related Experiment Videos

The aim of this study is to review the clinical outcomes of patients undergoing cataract extraction in conjunction with the implantation of the AlphaCor artificial cornea. This investigation seeks to address the lack of clarity regarding the safety and efficacy of combining these two distinct ophthalmic procedures. The researchers intend to document the specific technical challenges encountered when operating through this synthetic device. By analyzing data from a multicenter trial, the study explores whether lens removal increases the risk of adverse postoperative events. The authors focus on identifying why visual performance might differ between patients receiving the implant alone and those requiring additional lens surgery. This work also examines the frequency of complications like glaucoma and tissue melting in this patient population. The motivation for this review stems from the need to establish better surgical protocols for managing complex corneal and lens conditions. Ultimately, the study provides a critical assessment of current practices to guide future clinical decision-making.

Main Methods:

The review approach involved analyzing data from a nonrandomized multicenter clinical trial protocol. Investigators examined cases where lens extraction occurred either concurrently with or following the placement of the synthetic device. Five patients underwent extracapsular lens removal alongside the primary implantation procedure. One additional subject required the removal of a displaced lens after experiencing severe blunt trauma. The team evaluated surgical difficulty by documenting the restricted visual field and the presence of retained soft lens fragments. Researchers compared these findings against a control group of patients who received the implant without concurrent lens procedures. This methodology allowed for a systematic assessment of complication rates and visual acuity metrics. The study synthesized these observations to identify patterns in postoperative recovery and adverse events.

Main Results:

Key findings from the literature indicate that the incidence of postoperative complications, such as tissue melt and glaucoma, is higher in cataract cases. The mean best corrected visual acuity was found to be worse in patients requiring lens removal compared to those without. Five cases involved concurrent extracapsular extraction and intraocular lens placement. One patient required secondary intervention to remove a displaced lens following trauma. The data reveal that maintaining a clear view during the operation remains a primary challenge for surgeons. Residual soft lens matter was frequently observed due to the restricted visualization provided by the artificial surface. The analysis shows that these combined procedures present unique risks not seen in patients receiving the implant alone. These results quantify the significant hurdles clinicians face when managing lens opacities in eyes with synthetic corneal replacements.

Conclusions:

The authors propose that the current surgical approach for lens removal in these patients requires significant refinement to improve safety. Synthesis and implications from the data suggest that postoperative complications occur more frequently when cataract surgery is involved. Researchers indicate that tissue melting represents a serious risk that might be mitigated through specific topical steroid therapies. The evidence implies that visual outcomes remain inferior for patients undergoing these combined procedures compared to those receiving the implant alone. The study suggests that clinicians should utilize postoperative imaging to detect any remaining lens material that could trigger inflammation. Authors emphasize that identifying residual soft matter allows for the timely adjustment of anti-inflammatory medication regimens. The findings highlight that glaucoma incidence appears elevated in this specific patient cohort following the combined intervention. This review underscores the necessity for cautious surgical planning when managing lens opacities in eyes with synthetic corneal replacements.

The study utilizes data from a nonrandomized multicenter clinical trial. This design allows for the evaluation of real-world surgical outcomes across different centers, providing a broader perspective on the safety and efficacy of the combined intervention than a single-site study.

The authors report that melting appears to be preventable by using topical medroxyprogesterone 1% therapy. This specific medication is proposed as a strategy to manage the increased risk of tissue degradation observed in these complex cases.

The researchers state that the technique for cataract surgery in these patients needs to be refined. They imply that future surgical protocols must address the technical difficulties and high complication rates identified in this review to improve patient care.